Provider Demographics
NPI:1134800659
Name:WILLIS, KEYSHA NICOLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:KEYSHA
Middle Name:NICOLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 QUINCY LOOP
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4542
Mailing Address - Country:US
Mailing Address - Phone:404-276-7296
Mailing Address - Fax:
Practice Address - Street 1:4360 CHAMBLEE DUNWOODY RD STE 515
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-1076
Practice Address - Country:US
Practice Address - Phone:404-974-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty